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Dance Registration Form
Dance Studio Registration for Image Dance Company & Academy. Please fill out as completely as possible.
First and last name
Student's Date of Birth
Parent's/Guardian's Phone Mobile #
Parent's Guardian's Home/Work #
Please specify if home or work.
Additional Parent/Guardian name
Additional Parent/Guardian contact # or email
please specify if mobile/work/or home #
How did you hear about Image Dance Co. & Academy
Social Media (Facebook/Twitter/Nextdoor, Linked In etc.)
Promotion or Presentation by Performers
Which classes are you interested in?
Ballet or Creative Movement
Classical Spanish/Regional Spanish dance
Waiver & Liability Release
I release Michelle Angulo-Pacheco and Image Dance Company & Academy, any of its representatives ofvolunteers , management or instructors, HEB Grocery Company, PC, owner of premises, HEB Shopping Center Development, from any personal injuries to myself, my children (students or non-students) of the studio, or to any person within the premises of Perrin Oaks Shopping Center or to 4105 Avenida Prima, San Antonio, TX 78217. * I also give permission to Image Dance Co. & Academy and Michelle Angulo-Pacheco, director, to utilize pictures taken at classes and/or performances for advertising and promotional purposes with no expectations of monetaryor credit reimbursement. I understand that these shall be in good taste AND are for the promotional purposes ofthe dance studio and its performance and community activities with the clients and students.
Please check and follow link to pay registration fee.
Please check both. Link leads to the policy book
I agree to read the policy handbook and shall take initiative to familiarize myself with all its content.
A copy of your responses will be emailed to the address you provided.
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